TY - JOUR TI - Attention-deficit hyperactivity disorder symptoms and brain morphology: Examining confounding bias AU - Dall'Aglio, Lorenza AU - Kim, Hannah H AU - Lamballais, Sander AU - Labrecque, Jeremy AU - Muetzel, Ryan L AU - Tiemeier, Henning A2 - Zhou, Juan Helen A2 - Roiser, Jonathan A2 - Catellanos, Francisco Xavier VL - 11 PY - 2022 DA - 2022/11/09 SP - e78002 C1 - eLife 2022;11:e78002 DO - 10.7554/eLife.78002 UR - https://doi.org/10.7554/eLife.78002 AB - Background:. Associations between attention-deficit/hyperactivity disorder (ADHD) and brain morphology have been reported, although with several inconsistencies. These may partly stem from confounding bias, which could distort associations and limit generalizability. We examined how associations between brain morphology and ADHD symptoms change with adjustments for potential confounders typically overlooked in the literature (aim 1), and for the intelligence quotient (IQ) and head motion, which are generally corrected for but play ambiguous roles (aim 2). Methods:. Participants were 10-year-old children from the Adolescent Brain Cognitive Development (N = 7722) and Generation R (N = 2531) Studies. Cortical area, volume, and thickness were measured with MRI and ADHD symptoms with the Child Behavior Checklist. Surface-based cross-sectional analyses were run. Results:. ADHD symptoms related to widespread cortical regions when solely adjusting for demographic factors. Additional adjustments for socioeconomic and maternal behavioral confounders (aim 1) generally attenuated associations, as cluster sizes halved and effect sizes substantially reduced. Cluster sizes further changed when including IQ and head motion (aim 2), however, we argue that adjustments might have introduced bias. Conclusions:. Careful confounder selection and control can help identify more robust and specific regions of associations for ADHD symptoms, across two cohorts. We provided guidance to minimizing confounding bias in psychiatric neuroimaging. Funding:. Authors are supported by an NWO-VICI grant (NWO-ZonMW: 016.VICI.170.200 to HT) for HT, LDA, SL, and the Sophia Foundation S18-20, and Erasmus University and Erasmus MC Fellowship for RLM. KW - brain structure KW - ADHD KW - confounding JF - eLife SN - 2050-084X PB - eLife Sciences Publications, Ltd ER -